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Proteus mirabilis and its role in dacryocystitis.
Optom Vis Sci. 2014 Sep; 91(9):e230-5.OV

Abstract

PURPOSE

Dacryocystitis is a common inflammation of the lacrimal sac, usually from an underlying bacterial infection. Most cases can be attributed to common ocular flora such as Staphylococcus aureus or Streptococcus pneumoniae; however, uncommon bacterial causes such as Proteus mirabilis can still occur. P. mirabilis is a gram-negative bacillus that is found abundantly in people who have undergone long-term catheterization and is uncommonly found in or around the eyes except in people who have undergone long-term catheterization. Proteus species can cause conjunctivitis, canaliculitis, and dacryocystitis and have the ability to manifest into preseptal cellulitis; therefore, timely recognition and treatment are important to prevent potential further complications.

CASE REPORT

An 84-year-old white man had several recurrences of acute dacryocystitis that had marginal improvement with empiric antibiotic treatment. Resultant culture of the ocular discharge revealed an uncommon bacterium, P. mirabilis. Successful dosing of oral antibiotics resolved the infection but ultimately the patient required an external dacryocystorhinostomy (DCR) procedure to maintain patency of the nasolacrimal lacrimal system and prevent recurrence. At 3 months after external DCR, the patient was symptom free with no recurrences.

CONCLUSIONS

Dacryocystitis has a distinctive clinical presentation and is usually easily treated when appropriate oral antibiotics are directed at the underlying pathogen. In nonresponsive cases, culturing of the ocular discharge should be performed to identify the underlying pathogen. Cases of dacryocystitis caused by Proteus species are usually responsive to several standard antibiotics used orally in eye care; however, culturing and susceptibility testing can streamline the diagnostic and management sequence considerably in unclear or unresponsive cases. Typically, patients with dacryocystitis return to normal after appropriate treatment, but chronic recurrences and epiphora are potential sequelae. Patients should be educated that a DCR surgical procedure may be needed to prevent future recurrences in some cases.

Authors+Show Affiliations

*OD, FAAO Southern College of Optometry, Memphis, Tennessee.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

25036545

Citation

Borgman, Christopher J.. "Proteus Mirabilis and Its Role in Dacryocystitis." Optometry and Vision Science : Official Publication of the American Academy of Optometry, vol. 91, no. 9, 2014, pp. e230-5.
Borgman CJ. Proteus mirabilis and its role in dacryocystitis. Optom Vis Sci. 2014;91(9):e230-5.
Borgman, C. J. (2014). Proteus mirabilis and its role in dacryocystitis. Optometry and Vision Science : Official Publication of the American Academy of Optometry, 91(9), e230-5. https://doi.org/10.1097/OPX.0000000000000347
Borgman CJ. Proteus Mirabilis and Its Role in Dacryocystitis. Optom Vis Sci. 2014;91(9):e230-5. PubMed PMID: 25036545.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proteus mirabilis and its role in dacryocystitis. A1 - Borgman,Christopher J, PY - 2014/7/19/entrez PY - 2014/7/19/pubmed PY - 2014/12/15/medline SP - e230 EP - 5 JF - Optometry and vision science : official publication of the American Academy of Optometry JO - Optom Vis Sci VL - 91 IS - 9 N2 - PURPOSE: Dacryocystitis is a common inflammation of the lacrimal sac, usually from an underlying bacterial infection. Most cases can be attributed to common ocular flora such as Staphylococcus aureus or Streptococcus pneumoniae; however, uncommon bacterial causes such as Proteus mirabilis can still occur. P. mirabilis is a gram-negative bacillus that is found abundantly in people who have undergone long-term catheterization and is uncommonly found in or around the eyes except in people who have undergone long-term catheterization. Proteus species can cause conjunctivitis, canaliculitis, and dacryocystitis and have the ability to manifest into preseptal cellulitis; therefore, timely recognition and treatment are important to prevent potential further complications. CASE REPORT: An 84-year-old white man had several recurrences of acute dacryocystitis that had marginal improvement with empiric antibiotic treatment. Resultant culture of the ocular discharge revealed an uncommon bacterium, P. mirabilis. Successful dosing of oral antibiotics resolved the infection but ultimately the patient required an external dacryocystorhinostomy (DCR) procedure to maintain patency of the nasolacrimal lacrimal system and prevent recurrence. At 3 months after external DCR, the patient was symptom free with no recurrences. CONCLUSIONS: Dacryocystitis has a distinctive clinical presentation and is usually easily treated when appropriate oral antibiotics are directed at the underlying pathogen. In nonresponsive cases, culturing of the ocular discharge should be performed to identify the underlying pathogen. Cases of dacryocystitis caused by Proteus species are usually responsive to several standard antibiotics used orally in eye care; however, culturing and susceptibility testing can streamline the diagnostic and management sequence considerably in unclear or unresponsive cases. Typically, patients with dacryocystitis return to normal after appropriate treatment, but chronic recurrences and epiphora are potential sequelae. Patients should be educated that a DCR surgical procedure may be needed to prevent future recurrences in some cases. SN - 1538-9235 UR - https://www.unboundmedicine.com/medline/citation/25036545/Proteus_mirabilis_and_its_role_in_dacryocystitis_ L2 - https://doi.org/10.1097/OPX.0000000000000347 DB - PRIME DP - Unbound Medicine ER -